Endotracheal tube splitter

ABSTRACT

An endotracheal tube splitter and a method for removing an endotracheal tube are disclosed. The endotracheal tube splitter includes a handle portion, a cutting edge for cutting the endotracheal tube as it is withdrawn from a patient, and a support member for preventing the cutting edge from turning to either side and for maintaining the cutting edge at least a minimum desired distance from the face of the patient. The endotracheal tube splitter allows the more rapid replacement of the endotracheal tube, and allows a bronchoscope to be used as the guide for placing the tube.

BACKGROUND OF THE INVENTION

The present invention relates to a device and method for removing andreplacing an endotracheal tube, and in particular to an endotrachealtube splitter for facilitating the replacement of endotracheal tubes.

The use of endotracheal tubes to facilitate mechanical respiration orventilation in certain hospital and nursing home patients with variousrespiratory problems is well known to those skilled in the art. The tubeis usually passed through the patient's mouth or nose so that a bottomend of the tube fits snugly in the patient's trachea, while a top endremains extending out of the patient's mouth or nose. In this position,the endotracheal tube enables the patient to be mechanically ventilatedor to breath freely, uninterrupted by the respiratory disorder or otherlimitations.

For a variety of reasons, such as the prevention of infections or thefailure of a cuff disposed along the tube, the endotracheal tube must bereplaced periodically. Prior to the present invention, this was done bysliding one end of an elongate guide down the endotracheal tube andgently sliding the endotracheal tube out of the patient and over anopposing end of the guide. The replacement endotracheal tube was thenslid onto the guide, and then down the guide until it lodged in theproper place in the trachea. A guide for replacing the endotracheal tubein this manner is shown in U.S. Pat. No. 4,960,122.

As will be appreciated by those skilled in the art, this approach hasseveral limitations. First, time is of the essence when replacing theendotracheal tube, as removal and replacement of the tube causesdisturbances to the patient's ability to breath. Taking the oldendotracheal tube off the guide and threading on the new endotrachealtube adds time to the procedure. Second, such an approach inhibits theuse of a bronchoscope during the procedure, instead relying on a simpleguide. If a bronchoscope were to be used in accordance with theteachings of the prior art, the limitations of the endotracheal tubewould require that the end of the bronchoscope outside of the patientmust have an ending which is no bigger than the inner diameter of theendotracheal tube, or an end which is detachable.

In accordance with the present invention, it has been found thatsplitting the endotracheal tube as it is withdrawn from the patient'smouth provides a superior method for replacing the tube. First, the timeto replace the endotracheal tube is reduced by splitting the tube as itis withdrawn so that the replacement tube can be prethreaded over thebronchoscope. Second, the splitting of the tube allows a bronchoscope tobe used to view the trachea of the patient as the tube is beingwithdrawn and as the replacement tube is positioned in the trachea.

The use of a cutting device to remove a tube is not new. For severalyears the thin tubes used for introducing catheters have been cut asthey are withdrawn from the patient. However, there are severalimportant differences between using a cutting device to remove acatheter introducer and an endotracheal tube. First, when cutting anintroducer, time is generally not of the essence. The introducer may bewithdrawn at any comfortable rate. Second, in most catheterarrangements, the opposing end of the catheter is well placed in thebody and slight jerks on the catheter line will not displace thecatheter. Third, the introducer tubing is generally soft and flexible.

In contrast, when removing a endotracheal tube, time is of the essence.Typically, the tube must be removed and replaced within about 30seconds. Additionally, the endotracheal tube must be removed verycarefully in that a sudden jerk will often displace the end of thebronchoscope from the trachea into the patient's esophagus. Furthermore,the endotracheal tube is relatively rigid and typically much moredifficult to cut than is the tubing of the introducer.

An additional concern with the catheter introducer cutting devices ofthe prior art is that many have a relatively exposed blade. Because ofthe introduction location of most catheters, significant protectionaround the blade is not needed. Even if a slip does occur, the cutterwill only cause a small cut to the skin of the patient. In contrast, theuse of such a cutter to split an endotracheal tube would be extremelydangerous adjacent the face, as a slip could result in cutting thepatient's lip, nose, or worse, putting out the patient's eye.

Thus, there is a substantial need for a endotracheal tube splitter whichsafely and efficiently splits an endotracheal tube as it is removed froma patient so that a replacement tube may be quickly positioned in thetrachea.

SUMMARY OF THE INVENTION

It is an object of the invention to provide an endotracheal tubesplitter for use in replacing endotracheal tubes.

It is another object of the invention to provide such a tube splitterwhich is inexpensive and easy to use.

It is another object of the invention to provide a method for removingand replacing an endotracheal tube.

It is a further object of the invention to provide an endotracheal tubesplitter which protects the face of the patient from accidentallacerations as the tube is withdrawn and replaced with a newendotracheal tube.

The above and other objects of the invention are realized in specificillustrated embodiments of an endotracheal tube splitter including ahandle for holding the tube splitter, and a cutting portion attached tothe handle. The cutting portion includes a cutting blade, a guide and aplurality of curvatures to cut the endotracheal tube, and to prevent thecut tube from accidentally catching on the bronchoscope and dislodgingthe bronchoscope from the trachea of the patient as the tube is removed.

In accordance with another aspect of the invention, a support isprovided to prevent the cutting portion of the endotracheal tubesplitter from accidentally contacting the face of the patient. Thesupport may be a member extending from the handle which contacts theface of the patient, or may be a restraining device which attaches tosome other object in order to prevent the endotracheal tube splitterfrom passing below a certain point and into contact with the patient'sface.

In accordance with yet another aspect of the invention, the endotrachealtube splitter includes an alignment mechanism to ensure that theendotracheal tube is withdrawn and cut at the proper angle.

BRIEF DESCRIPTION OF THE DRAWINGS

The above and other objects, features and advantages of the inventionwill become apparent from a consideration of the following detaileddescription presented in connection with the accompanying drawings inwhich:

FIG. 1 shows a top view of an endotracheal tube splitter made inaccordance with the principles of the present invention.

FIG. 2 shows a fragmented side view of the endotracheal splitter of FIG.1, including the cutting portion of the splitter.

FIG. 3 shows an alternate embodiment of the invention to that shown inFIGS. 1 and 2.

FIGS. 4A through 4E show a cross-sectional view of a human head and neckwith an endotracheal tube positioned therein, and demonstrate the stepsof replacing an endotracheal tube in accordance with the teachings ofthe present invention.

DETAILED DESCRIPTION

Reference will now be made to the drawings in which the various elementsof the present invention will be given numeral designations and in whichthe invention will be discussed so as to enable one skilled in the artto make and use the invention. Referring to FIG. 1, there is shown anendotracheal tube splitter, generally designated at 10. The tubesplitter 10 includes a handle portion 14, a cutting portion 18, and asupport member 22 which extends from the handle portion in a mannerdiscussed in FIG. 2. The support member 22 is typically attached to thehandle portion 14 by a screw 26 or some other convenient fasteningdevice.

As shown in FIG. 1, the handle portion 14 has a plurality of holes, suchas hole 30, which are present to enable the handle portion to be of acomfortable size to be gripped by a human hand without excess weight orwaste of materials. Typically, the handle portion 14, the support member22 and most portions of the cutting portion 18 will be made of alightweight, durable polycarbonate material. However, other materialssuch as surgical steel could also be used.

On the handle portion 14, adjacent the cutting portion 18 may bedisposed a sight alignment 34 for ensuring that the endotracheal tubesplitter 10 is properly aligned as it moves along the endotracheal tube,represented by the dashed lines 40.

As will be explained in additional detail with respect to FIG. 2, thecutting portion 18 has several curvatures which help the endotrachealtube splitter 10 to cut the endotracheal tube 40 quickly and with littledisturbance to the bronchoscope (not shown) which is used to place thereplacement endotracheal tube. The curvature 50, in the forwardmost end54 of the cutting portion 18 is generally concave so as to protect thebronchoscope which is typically made of a fiber optic cable covered in avinyl sheath. Its radius of curvature is typically slightly larger thanan outer radius of curvature for a bronchoscope. A pair of curvatures 58slightly behind the forwardmost end 54 of the cutting portion 18 form awedge so as to force apart opposing sides of the split endotracheal tube40 so that the sides do not grab the bronchoscope as the endotrachealtube is pulled out of the patient's mouth and off of the bronchoscope.

Referring now to FIG. 2, there is shown a fragmented perspective view ofthe endotracheal tube splitter 10 discussed regarding FIG. 1 andnumbered accordingly. The forwardmost end 54 of the cutting portion 18extends downward to a elongate point so as to form a lip guide 62. Thelip guide 62 helps to prevent the cutting portion from rotating toeither side while cutting through the tube.

Those skilled in the art will recognize that a significant problem inremoving endotracheal tubes is a small hole formed in the tube near itsend, commonly referred to as a Murphy's eye (290 FIG. 4D). If thecutting device is not designed properly, the cutting blade may come outof the endotracheal tube as it passes through Murphy's eye. This cancause two major problems. First, the sudden change in resistance maycause the medical personnel withdrawing the tube to slip and laceratethe face of the patient. Second, the removal of the cutting blade leavesa small length of tube uncut and prevents rapid replacement with anotherendotracheal tube. By providing the elongate lip guide 62, the problempresented by Murphy's eye is overcome, as the guide keeps the cuttingblade 66 in the proper position so as to finish the cutting.

Above the cutting blade 66, the curvatures 58 taper to a point 70 so asto form a wedge. As the cutting blade 66 passes through a wall of anendotracheal tube, the wedge formed by the curvatures 58 forces the twosides of the cut endotracheal tube apart so that they will not catch onthe bronchoscope as the endotracheal tube is removed (See FIG. 4C). Therearward most portion 74 of the curvatures 58 is broadly rounded so thatit will not catch on the inflatable cuff (FIG. 4A) near the bottom ofthe endotracheal tube as it is drawn past the cutting blade 66.

Also shown in FIG. 2, the support member 22 will typically have a broadbase layer 80 made of a force absorbing, slip resistant material. As theendotracheal tube splitter 10 is used to cut the endotracheal tube beingremoved, a significant amount of force can be placed on the face of thepatient. The material prevents bruising to the face of the patient, andprevents the support member 22 from slipping on the patient's faceduring removal of an endotracheal tube. The material used for the baselayer 80 will typically be foam rubber or an elastomeric material.Preferably, the support member 22 and base layer 80 will hold thecutting blade 66 between one and three inches from the face of thepatient. However, any distance of at least one inch will generally besufficient.

The broad base layer 80 also rests snugly against the patient's face tominimize the tendency of the cutting portion 18 to turn to either side.By keeping the cutting blade 66 balanced and oriented straight down, thetube is cut more efficiently and correctly on the first attempt.

Referring now to FIG. 3, there is shown another embodiment of thepresent invention. The endotracheal tube splitter 110 includes a handleportion 114, and a cutting portion 118, including curvatures 122, and acutting blade 126 adjacent the forwardmost end 130. A sight alignment134 is also provided in a position generally parallel to a cutting planeof the cutting blade 126 so that the user may be assured that thecutting blade is not rotating to either lateral side.

In contrast to the embodiment discussed in FIGS. 1 and 2, however, asupport member does not extend downward from the handle portion 114 soas to rest on the face of a patient. Instead, a support band 140 isprovided which extends from the upper surface of the handle portion. Thesupport band 140 may be made of several different lengths so that it maybe attached to a convenient base, such as an IV bottle stand or somesort of stable overhead device. The length of the support band 140 isselected so that at full extension, the band holds the handle portion140 one to three inches above the patient's face. In the event theperson using the splitter 110 slips while cutting the endotracheal tube,the support band 140 will prevent the cutting blade 126 from contactingthe patient. The support band 140 also helps the user to preventrotation of the blade 126, as would be evidenced by the slight alignment134.

In FIGS. 4A through 4E, there is shown the steps which would normally beconducted in removing an endotracheal tube from a patient and replacingit with a new endotracheal tube. Referring specifically to FIG. 4A,there is shown a cross-sectional view of human head 200 and neck 204. Anendotracheal tube 208 is placed so that a first end 210 is positioned inthe patient's trachea 216 and a second end 214 extends out of thepatient's mouth 212. An inflatable cuff 220 is provided to seal betweenthe endotracheal tube 208 and the trachea, thereby allowing protectionof the airway against aspiration and allowing mechanical ventilation.

Referring now to FIG. 4B, a bronchoscope 230 is slid into theendotracheal tube 208 so that a proximal end 234 of the bronchoscopeextends slightly past the endotracheal tube in the trachea 216. Prior tothe present invention, an elongate guide (not shown) would be positionedinto the endotracheal tube 208 as is the bronchoscope 230. Theendotracheal tube 208 would be slid out of the patient's mouth and offof the guide. A replacement endotracheal tube would then be slid ontothe guide and slid into the position previously occupied by the removedendotracheal tube 208. In the present invention, however, there is noneed to use a simple guide, and no need to remove the old endotrachealtube before loading the replacement endotracheal tube. As is shown inFIG. 4B, the replacement endotracheal tube 242 is preloaded on abronchoscope 230 which can be used to view the trachea 216 during theprocedure.

Referring now to FIG. 4C, the endotracheal tube splitter 250 ispositioned so that the lip guide 254 extends down into the endotrachealtube 208. A pair of forceps 260 or a similar holding device is used tograb the endotracheal tube and slowly remove it from the patient therebydrawing the endotracheal tube away from the patient's face. The forceps260 are helpful because the tubing of the endotracheal tube 208 isslippery and difficult to cut and hold by hand.

As the old endotracheal tube 208 is pulled from the patient's mouth 212,the endotracheal tube splitter 250 cuts the endotracheal tube 208 andpushes apart the cut sides 258 of the tube so that they do not catch onthe bronchoscope 230. This is important because jarring the bronchoscope230 could dislodge it from the trachea 216 and cause it to become lodgedin the esophagus 264.

For additional stability, and to prevent the lip guide 254 or thecutting blade (not shown) from contacting the patient, the supportmember 270 is positioned so that the base layer 274 extends transversewith respect to the handle 256 and rests on the chin or other portion ofthe patient's face. The base layer 274 prevents the force accompanyingthe cutting of the old endotracheal tube 208 from bruising the patient,and also prevents the support member 270 from slipping on the patient'sskin.

Because the old endotracheal tube 208 has been cut through its entirelength (including Murphy's eye 290), it may be removed from thebronchoscope 230 quickly and easily, as is shown in FIG. 4D. Once theold endotracheal tube 208 has been removed, the endotracheal tubesplitter 250 is put away and the new endotracheal tube 242 is slid alongthe bronchoscope 230 until the cuff 246 of the endotracheal tube 242 islodged properly in the trachea 216. The bronchoscope 230 is thenwithdrawn, as shown in FIG. 4E, leaving the new endotracheal tube 242 inits proper place.

The endotracheal tube splitter 250 allows the removal and replacement ofthe old endotracheal tube 208 safely and efficiently in about 30 to 40seconds or less. This small amount of time is easier on the patient, andis less complicated for medical personnel.

Thus there is disclosed an endotracheal tube splitter for removingendotracheal tubes and a method for replacing endotracheal tubes. Thoseskilled in the art will recognize numerous modifications which can bemade to the splitter without departing from the scope and spirit of theinvention. The appended claims are intended to cover such modifications.

What is claimed is:
 1. An endotracheal tube splitter for removingendotracheal tubes from an inhibating position within a patient whereina first end of the endotracheal tube is disposed in the trachea and asecond end is adpated to be disposed outside the patient, the splittercomprising:handle means configured for gripping by a human hand; cuttingmeans connected to the handle means for cutting through the endotrachealtube from the second end to the first end as the tube is withdrawn fromthe patient, stabilizing support means coupled to the handle means forinhibiting rotation of the cutting means so as to facilitate cutting ofthe endotracheal tube in a generally straight line continuously betweenthe second and first ends, and for holding the cutting means at least apredetermined minimum distance from the patient, wherein the cuttingmeans comprises a cutting blade and a forwardmost end defining a guidemeans for insertion into the endotracheal tube and for guiding thecutting blade along the endotracheal tube, and wherein the guide meanscomprises a first side for sliding along the endotracheal tube and asecond, forwardmost side having a concave curvature.
 2. The endotrachealtube splitter of claim 1, wherein the endotracheal tube splitter isconfigured for cutting an endotracheal tube from about a bronchoscopehaving a convex outer surface disposed within the endotracheal tube, andwherein the second, forwardmost side has a radius of curvature of atleast as large as the outer surface of the bronchoscope.
 3. Anendotracheal tube splitter for removing endotracheal tubes from aninhibating position within a patient wherein a first end of theendotracheal tube is disposed in the trachea and a second end is adpatedto be disposed outside the patient, the splitter comprising:handle meansconfigured for gripping by a human hand; cutting means connected to thehandle means for cutting through the endotracheal tube from the secondend to the first end as the tube is withdrawn from the patient,stabilizing support means coupled to the handle means for inhibitingrotation of the cutting means so as to facilitate cutting of theendotracheal tube in a generally straight line continuously between thesecond and first ends, and for holding the cutting means at least apredetermined minimum distance from the patient, wherein the stabilizingsupport means comprises a support member extending generally downwardlyfrom the handle means for resting on the patient's face; and wherein thesupport member has an upper portion for attachment to the handle meansand a broad base portion extending transverse with respect to the handlemeans for resting on the patient's face.
 4. The endotracheal tubesplitter of claim 3, wherein the cutting means further comprises a pairof lateral sidewalls forming a wedge above the cutting blade fordeflecting cut sides of the endotracheal tube away from one another. 5.The endotracheal tube splitter of claim 4, wherein the wedge comprisesgenerally concave curved sidewalls.
 6. The endotracheal tube splitter ofclaim 3, wherein the stabilizing support means extends downwardly so asto hold the cutting means at least one inch from the patient's face. 7.The endotracheal tube splitter of claim 3, wherein the base portioncomprises a base layer disposed at an end of the base portion oppositethe upper portion, the base layer comprising a slip resistant surface.8. The endotracheal tube splitter of claim 3, wherein the base portioncomprises a base layer disposed at an end of the base portion oppositethe upper portion, the base layer comprising a force absorbing material.9. The endotracheal tube splitter of claim 3, further comprising sightalignment means positioned generally parallel with a cutting plane ofthe blade for assisting in proper alignment of the cutting means andminimizing rotation of the blade to either lateral side.